Provider Demographics
NPI:1811052046
Name:MEDEIROS, JOANNA LYNN
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:LYNN
Last Name:MEDEIROS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:LYNN
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1357 PAWTUCKET AVE
Mailing Address - Street 2:
Mailing Address - City:RUMFORD
Mailing Address - State:RI
Mailing Address - Zip Code:02916
Mailing Address - Country:US
Mailing Address - Phone:401-438-5748
Mailing Address - Fax:
Practice Address - Street 1:1563 N MAIN ST
Practice Address - Street 2:SUITE 208
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720
Practice Address - Country:US
Practice Address - Phone:508-324-1060
Practice Address - Fax:508-679-8590
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist